Posted - 07/30/2007 : 23:56:33
| hi all, this is only my third post so bear with me if it sounds weird!
does anyone have any news on the GMC case for Andy Wakefield and his colleagues or is the government and the DoH keeping it quiet and minimising publicity over it (after all, they can't disprove his theory, only pick flaws in conduct).
please post me any info you can as i am having great trouble finding details on this case, and i am interested to know because i believe the man is great for going against the DoH and our government to protect our children, and if i had the evidence he found and the expertise to back it up i'd have done the same thing.
our government are acting like making us pay taxes while they turn our lives and those of our children into one big circus. well not anymore. one day there will be proof enough of the effects of mmr, and on that day, the DoH will be crippled by so many compensation claims its unreal. but at the cost of thousands of innocents? this is wrong.
good news is, on thursday, my health visitor will ask me if my son is having his mmr, and when she does, she'll be told that that vaccine will never be given to any of my children and if the issue is bought up again i will change to another surgery who can accept my choice for what it is. And if she asks why, i'll just ask how many ink cartridges she'll give me for my printer, how many tapes for my dictophone, how much money for photocopies of library documents, and whether she'd like me to describe in detail how it felt waiting for 4 years for my sister to say my name and say nan nite sar sar again before she went to sleep. And if her face is empty when i say these things, well maybe that moment of silence could compare to the silence i've felt reading and hearing some of the research and experiences of others - some of whom found out the hard way what mmr really is about, and what it can do to a child.
measles mumps and rubella can be mild and most children survive and recover in weeks. Autism caused by mmr is for life. i know which i'd prefer. and the DoH cant lie their way around that because i've made my choice.
Posted - 07/31/2007 : 11:08:22
| Hi Draconia - you dont sound weird at all. Just angry - like so many other parents whose family members have been damaged by vaccines.
I think Gus posted a message saying that details of the GMC case weren't to emerge till after the entire hearing is over - in October. But I cant find the post now.
Here's wishing you strength and wisdom for Thursday!
"Truth is not only violated by falsehood; it may be outraged by silence."
Posted - 07/31/2007 : 15:53:28
On the 16th July 2007 Professor Simon Murch, Professor John Walker-Smith and Dr. Andrew Wakefield began a 16 week hearing into allegations of professional misconduct. The initial allegations were made not by any patient but by an investigative ‘journalist’. On Monday, the first day of the hearing, the autism community worldwide showed its support of the doctors. Those who could make the journey gathered in front to of the GMC Building in London. The many thousands of children who could not be there on the day were represented by a floral display comprising flowers from petitioners all over the world. Check the cryshame.com site for more information and pictures about the GMC Rally...
CryShame and others– including JABS, Treating Autism and the Autism Treatment Trust - joined in showing support for these courageous men who did nothing more than put our children before the interests of global pharmaceutical profit. The GMC hearing is providing the world's press with a window on the world of deceit that underlies a catastrophic global increase in rates of autism spectrum disorders.
The Hearing Opens
Inside the Hearing: Dr Wakefield, Professor Walker-Smith and Professor Simon Murch on Trial
Inevitably the atmosphere inside the building was quite different from that outside. Inside the glass shell, there was a feeling of being in an underwater bubble. Anyone entering was greeted by an almost entirely black security personnel, attractively dressed young women with fixed smiles and confident young men in casual dress. On the third floor, through two sets of glass doors past a lounge area and the doors to the rooms provided for the press, off a corridor on the right is the entrance to the hearing room. All attendees in the public gallery and members of the press are searched before entering the long room.
About 60 foot long and 40 feet wide, the room is flanked by glass panels down one of its long walls. The atmosphere is one of quiet efficiency. There are between 30 and 40 participants in the hearing. The defendants and the adjudicators sit facing each other, the doctors with their legal teams are down the left hand side and the panel and GMC clerks down the right hand side.
It is difficult to imagine that this long mainly white room, with an oblong of tables in its centre, will be the daily place of work for the three doctor defendants in this case. For the next three months these highly trained doctors will have to defend many of the professional decisions which they have made over the last decade. Things that ‘just happened’ and that carried no particular importance at the time could now, in the light of this room, spell the end to their medical careers.
The room is not really like a court room, there is no central point of authority, although the principal prosecutor for the GMC, Miss Smith, sits at one end of the rectangular tables, she is not sitting higher than anyone else and is sometimes hardly noticeable amidst the books, boxes and reading rests that surround her. Nor are the ‘accused’ sitting together in a dock of any kind but dispersed amongst their lawyers.
Almost everyone in the room, outside the public area, is wearing black, its deadness only interrupted by the silver hair and white shirts of the men and on some women brief touches of ochre or translucent white of arms and legs. There is a round and almost classic clock on the wall at the far end of the room, on its face time passes very slowly.
The first days of any juridical hearings, whether they be at the Old Bailey or the General Medical Council (GMC) are always the worst for defendants. It is in these first days that the complainants or the prosecutors make their case, and knowing that they have a free hand in tarring the accused, prosecutors always over-egg the pudding.
Consequently, defendants find themselves powerlessly listening to an endless litany of their dishonesties and their dishonest nature. Amongst many unfairnesses introduced into the judicial process by the GMC on this first day, was an evidently unrestricted number of charges – Wakefield was faced with some 40 heads each broken down into two or three separate accusations, while Professor Walker-Smith and Professor Simon Murch faced counts in their twenties and thirties. Anyone who has ever had any experience of juries or tribunals knows full well that with so many charges the the adjudicators are inevitably faced with a quandary. As the mud is thrown at the wall some will inevitably stick. ‘Well’, they will say ‘We have found for the defendant on some of the charges, we have to find against them on some’.
Dr Andrew Wakefield, Professor Simon Murch and Professor Walker-Smith, the three accused, faced a formidable number of charges. In fact, they faced so many charges that one might imagine that the GMC had purposely covered every bit of green beige on the roulette table to ensure a victory, if not on the red or the black, then at least on number 38, para 1 (i) small a.
All three defendants, listened throughout the whole of Monday to a reading of the accusations first from the GMC and then from defence council and finally again, ‘just checking’ from the panel chairman. Like demonstrating a Chinese water torture, it would seem impossible for any member of the panel not to have been hypnotised into believing that the defendants were definitely guilty in triplicate. This strategy is perhaps equal in unfairness to the bizarre three year delay in formulating the charges; a delay that would probably not be tolerated in most third world regimes or still surviving Stalinist enclaves.
Of course, in a fairer system, the admissions and mutual agreements over some parts of the charges; those factual aspects which hold no legal or ethical value judgements, would all have been sorted out well away from the panel or the public, at a much earlier time.
Lawyers, however, enjoy this kind of legal accountancy, perhaps more than actually fighting cases or defending their clients. The hearing room echoed with bold legal statements such as:
18 (i), little 3 and little 5, is admitted as is 18 small k.
Each barrister seemed to revel in this soliloquy of small letters and numbers. And of course such terminally boring speeches, gave opportunity for the pearls of legal language to be dredged up from the deep.
‘Yes’ one barrister said to the Panel chair, ‘Sir, you are right and I am wrong’.
Brian Deer also faced his persecutors inside the building. During the morning break, two parents objected to sitting in the same public gallery space and indeed breathing the same air as him. There was nothing that the GMC could do about the air problem but ever eager to show fairness, security personnel roped off the section of the public gallery which contained Deer and the other embedded journalists.
Then at a break in the afternoon a security guard, checking under seats with the ‘wand’, thought he had found a bug under the seat next to that used by Deer. It turned out to be a fault in the machine and no device was found.
The sense of utter tedium, however, masks a very serious operation which is intent on stopping Dr Andrew Wakefield from ever again acting as a doctor in England and perhaps more exactly ensuring that he never appears as an expert witness in any cases of vaccine damaged children.
Posted - 07/31/2007 : 23:09:50
| The whole thing sounds "B***Y" awful, I do hope that Andrew and Co know how much support they have in the "Real" world!!!
Posted - 08/01/2007 : 10:06:50
| I think they do Bill. That description from CRYSHAME is so well written but sends shivers down your spine. There's someting so surreal about the whole proceedings. It's like a 'Good versus Evil' battle.
Posted - 08/08/2007 : 18:56:46
The Hearing Trundles On
17 to 20 July and 23 to 26 July
Martin J Walker
Legal cases, whether they be seen from the perspective of the prosecuting or defending counsel, are dependant upon narrative; the telling of a story. Unfortunately for Miss Smith, the GMC have provided her with an already threadbare narrative which because it is all she has, she proceeds to bang on about as if it were the dead parrot in the famous Monty Python sketch. Watching Miss Smith try to construct a believable story out of her information is heartbreaking for anyone who enjoys the legal process.
But what is even the best lawyer to do without a story? You could hum and haw your way through the whole production - making it up on the hoof so to speak - or you could take the strategy for which Miss Smith has opted.
This strategy involves hurling chunks of disconnected information at the defence in the hope that at the end of the hearing some damage will have resulted. Because her case contains few specifics and very little fact, each plank of Miss Smith’s prosecution is shaped in global terms.
In hearings of this kind, the nature of the defence is inevitably structured by the prosecution. So while it is clearly Miss Smith’s intention to filibuster her way through the case, the defence has to respond with a careful, exact and specifically detailed revision of the local facts. Because the prosecution is based on partial information and a threadbare story, the defence has to bring to light the facts which make the story whole.
They have done this with great dexterity in the first two weeks of the hearing. Defence counsel’s cross examination of the prosecution witnesses brought so far has been exemplary. They proceed quietly and with an erudite commitment to prizing out the truth. What is really exciting to watch is the way that defence counsel shape and place the bricks of their case with such smoothness that even the most professional of witnesses are unlikely to see the denouement.
Most of my experience of law is with criminal cases, where one is rarely dealing with complex arguments. The defendant knows not to say that he carried out the crime while the police have spent hours in the canteen checking their notes to ensure consensus about exactly what time the defendant went for a pee the day before the robbery. In the GMC case, however, the arguments are subtle and the whole craft of cross examination might be observed at its most intricate.
The Prosecution Case
On Tuesday 17 July, after a morning to discuss legal issues, particularly that of the confidential nature of children’s medical records, Miss Smith spent the afternoon giving a broad description of the prosecution case. She began with the words:
‘It boils down to simple allegations against a research project to do with a new syndrome’.
If other members of the public and the press were thinking that this broad description under a number of heads was the opening of the prosecution case, to be followed by witnesses, they were to be sadly disappointed.
On that Tuesday afternoon and for all day on Wednesday, Miss Smith presented almost every detail of the prosecution case. This presentation inevitably made one wonder why the GMC were bothering to call witnesses to the hearing, as Miss Smith appeared to have given much of the evidence herself.
At one point on Wednesday afternoon, during an analysis of the route by which the children were introduced to what the prosecution call ‘the research’, a problem associated with this style of presentation obviously occurred to the leading defence council. He stood, to ask why Miss Smith, while appearing to introduce the whole case in detail, had missed out large chunks of the narrative that did not support their case.
The idea of the defence asking the prosecution to include defence material in their opening remarks left me momentarily bewildered. And in fact Miss Smith slid easily from beneath the guillotine, explaining that it was not up to her to introduce facts which helped the defence case. The defence, she said, would have ample opportunity to bring these matters to the attention of the panel, during cross examination or during the presentation of the defence case.
When, defence council must have been thinking, would it be possible to correct this view that children had arrived at the ‘research’ in an unorthodox and unethical manner. If each child’s circumstances was not to be specifically presented as evidence, how was the defence to give a detailed map of each child’s route to the research?
In fact, although each child’s route to the Lancet case series is vital to the prosecution case, the children and parents have been left out of the hearing, obviously because they are all sympathetic to the defendants and furious about their prosecution. It is rather as if in a case of serious assault at the Old Bailey, the prosecution fail to bring the victim to give evidence because he insists that he was never assaulted.
When viewed from the perspective of the parents and children, the GMC hearing brings up other serious questions besides such things as research regulation and the power of pharmaceutical lobby groups. The hearing throws into our vision, the whole question of the individual’s right to choose medical interventions and the doctor and research workers’ right of freedom to prescribe and research in areas where policy is guided by corporations or governments.
The Case for the Prosecution
The prosecution has broken down the case against the three doctors under a number of heads, these are.
The Children: By presenting the GP’s of each child whose case was reported in the Lancet paper, the prosecution hope to show that Dr Wakefield, Professor Walker-Smith and Professor Simon Murch touted for children whom they had no intention of assessing, or treating, but to whom they wanted access for the sole purpose of research. The prosecution case is also that some of the children did not meet the criteria for ‘the study’; that some children did not present with symptoms which made them part of what the prosecution insist on calling the ‘disintegrative disorder’ group and that the defendants carried out unjustified, invasive, frightening and risky procedures on the children.
Ethical matters: The prosecution will try to show that from the beginning of the application to the ethical committee, Wakefield and others confused, if not lied about, their intentions. That after approval with reservations, the doctors went their own way. They will try to show that, amongst other things, the doctors broke ethical guidelines by enrolling children in research outside the time frame of the ethical approval; confused the GP’s about how the ‘research’ was being funded and failed to include details of ‘research’ procedures in the patients’ notes.
The Lancet paper: Under this head, the prosecution will try to show that Wakefield and others completely misled the editor of the journal, especially in that they were well aware of the serious nature of their conclusions and the damage which it might do to the nation’s public health. Part of the case against the paper is that Wakefield had failed to make a declaration of conflicting interests.
The Birthday Party: As the prosecution made the case, the taking of blood at a children’s party and the ‘inducement’ of £5 to each child was made far worse a crime after Wakefield told a story about it during a lecture in America. This telling of a humorous story was considered, ‘so inappropriate as to bring the medical profession into disrepute’. Of course, considering that the anecdote has always been the mainstay of both the medical and the legal profession, this is a culturally, if not legally, astounding position.
The actual case for the prosecution
Miss Smith went through the background to each of the children reported in the 1998 Lancet paper. She did her best to distance the children from any perceived vaccine-related event. She failed to mention that hundreds of other children had undergone the same procedures for clinically indicated reasons. She also failed radically to introduce the parents into the story. Had she done this, it would have become clear that, at the time and to this day, the parents were more than happy to have someone take an interest in their child’s illness and to share with them the terrible ordeal of having a damaged child without any real hope being held out to them.
The prosecution reported the cases of these children in the context of a health care system which is without fault. A health care system in which GP’s, for instance, always give parents the right advice and quickly reach correct diagnostic conclusions. In fact the reality is almost the opposite. All the GP’s who gave evidence followed the advice of parents that they wanted their children referred to the Royal Free specifically because no one else was able to offer a diagnosis.
The prosecution called a majority of the GP’s who initially dealt with the children whose cases were reported in the Lancet paper. There was some reluctance amongst a number of them to appear. This was summed up by one GP who responded acerbically to one question: ‘I have been drawn into something which is bigger than me and I would rather be back at my practice seeing patients’.
The clearest impression garnered while the GP’s were giving evidence is that the prosecution is doing everything they can to avoid bringing the children, the plight of the parents, vaccination or MMR into court.
As Miss Smith took the hearing through each of these cases, the children and their illnesses were all carefully distanced from their vaccinations or the possible adverse effect of these. Equally, the parents were very cleverly painted out of the picture, so that to all intents and purposes it appeared that they had been put into a terrible dilemma by a rogue doctor wanting to experiment on their children.
Just so that I could clear my mind on this matter, I asked one of the parents – of a child who was not actually included in the case series – whether she and her husband had been disturbed by the offer of tests given by the Royal Free team. ‘I think that my boy would have died if he hadn’t had the tests which were proposed’. ‘It was the logical step to take, we had absolutely no doubt at all about the tests’. She thought for a moment: ‘ I don’t know any parent who had any doubts about the tests’.
Listening to Miss Smith, one lost count of the number of times she said, ‘Neither the GP nor the Consultant mentioned that there were any gastrointestinal problems in this case’. To which one is bound to answer, ‘Well they wouldn’t would they, this is the reason they ended up with Dr Wakefield, who outlined a NEW syndrome’. This of course is the nature of serious scientific research, that medical research workers find solutions by looking at a numbers of cases, where GP’s remain confused by the experience of individual cases.
I have always thought that it would be the parents who will win this case and for that matter the campaign. From the beginning the ‘lobbyists’ have sent out a clear message that Wakefield is on his own; a ‘lone maverick’. Only the parents could save him from this description, by coming forward for the case and the campaign and making it clear that he has their full support.
However, when it comes to working with children and parents, lawyers have an approach similar to that which WC Fields had towards children and animals. They seem to be considered by lawyers as loose cannons. It is for this reason almost entirely that the real story will not come out of this hearing. What the hearing has done is refocus the matter entirely on Dr Wakefield, and to a smaller extent the other doctors, at the expense of the parents and children. It puts all the power into the hands of doctors at various levels of authority and takes away from the parents their experiential evidence of their children’s damage. In this, the defence is playing a similar game to the prosecution. Neither team wants the hearings to leak out beyond the professional domain and into the public.
Dr Pegg the Anaesthetist
On Tuesday July 25 Miss Smith began to address one of the main planks of the prosecution case; Dr Andrew Wakefield’s alleged failure to abide by ethical rules governing the practice of research. A lawyer with a good story might have started by leading the first witness through their evidence in chief, asking them to describe the role of ethics committees before moving on to tired old lines such as,
‘Was there a time in 1996 when Dr Andrew Wakefield approached the Royal Free ethical committee with a research project.’
If the answer is ‘yes’ then the project can be investigated.
Aware of her lack of story, Miss Smith began by reading what seemed like every pertinent document, word for word, which addresses ethics and research on human subjects. Having dealt with the historical and global, little of which had anything at all to do with anyone in the hearing, she then moved directly to the witness.
When, however, she asked Dr Pegg, Consultant Anaesthetist at he RFH and Chair of the hospital’s Ethics Committee, to agree the history of ethics in the developed world since the second world war, Dr Pegg immediately responded, ‘Yes but you have missed out the most important reference, The Declaration of Helsinki’. Miss Smith immediately hunkered down to read this document word for word as well.
Personally, I felt that Miss Smith missed a good opportunity when she failed to read out the Nuremburg Codes, which would quickly have tarred Dr Wakefield and his co-defendants as Nazi’s as well as mavericks.
In leading Pegg through his evidence-in-chief, Miss Smith kept her creature on a very short leash. But because she had hopelessly overcrowded the evidence with irrelevant detail, the shape of her narrative was lost, certainly on me and perhaps on the panel. Prosecuting with a witness such as Pegg, one needs to coax from him clear and simple ways in which the defendants had acted unethically. But Pegg was almost apologetic, and like the GP’s, of course, keen to watch his own back;
‘Don’t forget, these were the guidelines which we used 11 years ago’ and
‘Yes that was probably my secretary (referring to a wrongly dated letter) she was overworked’.
Oddly enough, Pegg, who clearly came across as having something simple to say about the defendants ignoring ethical guidelines, found himself guided by Miss Smith into byways of obfuscation. That, and the fact that in this complex case pages in evidence folders appeared frequently to rearrange themselves, provoking endless speculation about page numbering, inevitably drew attention to the weakness of the prosecution case.
When Pegg had been led through his evidence in chief, it looked as if the prosecution might have dug up a couple of sharp points about the doctors’ behaviour. Had the defendants not, for example, enrolled children in the ‘research’, before the start date granted by the ethics committee? Had they continued to give lumber punctures in some cases even though the ethics committee had warned them against this.
However, when Mr Miller rose to cross examine, holding a sheaf of papers which turned out to be letters, sequentially important in the actions of the RFH group, even these issues were well on the way to being resolved. When Miss Smith said with muted complaint,
‘I just want to make clear to the panel that we have not seen these letters’,
one was tempted to ask ‘Why not?’ was she saying that after three years of assembling the prosecution case, she had based her case on an incomplete exchange that had gone on between the defendants and the ethics committee?
Three quarters through the cross examination of Dr Pegg, the whole matter of documentation became even murkier. Looking for the rest of any exchange which might help his client Mr Miller asked Pegg:
‘Do you have any ethics committee records at the Royal Free?’
‘No there is no paper work. Everything is shredded after three years’.
The matter appeared to have been dropped but then an hour later, Miller approached it again.
‘You have no record of these letters?’
‘No we have no record, everything is shredded after three years’.
‘That seems a very short time to keep records’.
‘No everything has been digitised, after it has been digitised all the paper records are shredded’.
When Miller appeared surprised at the deception that had apparently been practiced on the defence. Pegg added scathingly.
‘If you want something, you can go and search through all the discs if you want’.
This in a tone of voice which suggested that what he meant by their being no records had been clear all along.
This was, amongst other of Pegg’s acerbic asides, an indication of his general attitude to the defence. Throughout his cross examination, his manner was unhelpful and truculent. At one point having answered a string of carefully framed questions from Mr Miller, with breath short stunted ‘yeses’, he answered the final one with:
‘Well I’ve answered all the others with yes, I might as well answer this with Yes as well’.
In a proper court, like so much else, this childishness would have earned Dr Pegg a rebuke, if not a warning, but in the court of Miss Smith, Dr Pegg, a creature of the prosecution was allowed to bring the tribunal into disrepute. Nor was Dr Pegg able to stop himself from openly insulting Mr Miller, suggesting in a hardly veiled manner that he was ‘stupid’ and perhaps illiterate.
The evidence of Dr Pegg must have left a bad taste in the mouths of many people in the hearing room. It was evidence which only the defence barristers walked away from with some kind of honour. Watching Miller, Koonan and Hopkins hold their tempers while revealing Pegg’s bolshi nature to the panel was an object lesson in how to cross examine a difficult and rude witness.
Just as the prosecution had, at the end of the day, been utterly unable to depend upon the general practitioner witnesses to state clearly that Dr Wakefield and his colleagues had trawled the country for children to experiment upon and then had failed to treat these children, so Dr Pegg failed to aid the prosecution in simplifying how Wakefield had broken the guidelines of the ethical committee.
The prosecution needed Dr Pegg to be able to make simple and obvious statements about how Dr Wakefield had acted unethically. However, because like the GP’s, Pegg also had to watch his own back, he seemed unable to accuse Wakefield in a straightforward manner.
Did Dr Wakefield or any member of his team write back and discuss the changes that the EC had asked for? Pegg wasn’t sure and had no records.
Was it just Dr Wakefield involved in this project? Pegg couldn’t really remember who was involved. When the signatures of around ten clinicians and technicians on the submitted forms were brought to his attention he seemed surprised.
But by far the biggest failure of Dr Pegg’s evidence came when he was asked about the requirement for applicants to declare sources of finance. He had to admit that, because of the routine way in which all funding had been handled by the RFH trustees, there was no requirement for a declaration of original sources of finance on Dr Wakefield’s (or anyone’s) part when completing the relevant ethics form. Given that such specific information about financial sources was not required in the financial section, it was unclear where one might make mention of it. The best Dr Pegg could do was to suggest that Dr Wakefield might at least have declared legal aid funding under ‘objectives of the study’, which seems rather odd to say the least.
The defence was clearly preparing the path for the argument which will inevitably take place around the authors’ failure to state any conflict of interest relating to the Lancet paper. On this matter Pegg was immensely helpful to the defence claiming that such matters were ‘…not even on the radar in 1996.’
A second key matter on which the defence was eager for commitment from Dr Pegg was whether a ‘case study’ - that is a clinical report of one or more similar cases – did or did not need ethical committee approval. On this matter, Pegg was hardly helpful to anyone. If the doctor concerned knew from the beginning of a case that he was going to write it up, then he needed ethical approval. If he did not initially intend writing up the case but did anyway, then he didn’t. This was a ridiculous explanation and one suspects it was made up on the hoof. What he probably meant to say, was that if individual children were examined for the sake of a scientific study then the doctor concerned needed ethical committee approval. If, however, all the children were seen on the basis of clinical need and at some point a number of the cases were written up, no ethical committee approval was needed.
On the evidence so far, after almost two weeks of the hearing, the defendants appear to be in very good shape. However, it will not be clear up until the last breath of the hearing what value the panel members will place on the evidence. With a case such as this, which has been in the public domain for over three years and which panel members have probably read about extensively, it would seem almost impossible that they do not have pre- conceived notions about the three defendants.
Transcripts were freely available through week one, when allegations were being read out without rebuttal. After cross examination began it was decided not to make them available any more.
* * *
Posted - 08/13/2007 : 19:19:10
Prosecuting For The Defence
Written by Martin J Walker
The GMC Hearing July 30th to August 6th
Despite having chosen to sit directly beneath the air conditioning vents in the hearing room, I occasionally nod off. On Wednesday of last week I had a very disconcerting experience, I nodded off during the evidence of Dr Berelowitz, a psychiatrist who was one of the co-authors of the Lancet paper and who acted at that time as a psychiatric-paediatric liaison worker.
I must have only dozed for a moment but it was long enough for me to become caught up in a disturbing dream which I now can’t remember. I can, however, remember just before I woke, my head was full of the sound of stampeding people, running and shouting as if they were trying to escape a natural disaster. I could see the front runners as they scrambled over everything in their path, amongst them I recognised Dr Berelowitz and realised that the deserting crowd were mainly witnesses fighting to get out through the door of the GMC hearing room. Behind them was Andrew Wakefield sitting completely alone apart from some vague ghosts of friends and his defence counsel.
I woke with a start and tuned back in to Berelowitz’s evidence. He was saying that he had been happy to be a part of the research which led to the Lancet paper. He was happy with the ethical position of the research team, yes, he was also happy with the investigative tests which were carried out on the children. As far as he was concerned such tests were common in the diagnosis of bowel disorders.
However, Berelowitz went on, he had been upset and disconcerted about what had happened at the press conference. As far as he was concerned, the Lancet paper should naturally have called an end to the rather spurious tenet of the research into any link between MMR and autism. The paper clearly stated that no link had been proven and Berelowitz, for some reason apparent only to himself, had taken this to mean that no link could ever be proven. On the basis of this fundamental and rather startling misunderstanding he had expected any future research to take a completely new direction. This, naturally, had proved not to be the case and Dr Berelowitz seemed unsure of who was to blame. Was it the media? Was it Andrew Wakefield?
He suggested that his relationship with Wakefield, and his association with the research, had utterly collapsed after the press conference. Berelowitz recounted the story of how a journalist friend, present at the press conference, had got up to interview Wakefield, who had just opined that perhaps use of the triple injection should be suspended until research definitively answered the question of a link between MMR and regressive autism. Berelowitz had apparently said to his friend, 'The story is here in the paper, it shows that there is no connection between MMR and autism', his friend had answered, 'No, the story is over there with Wakefield'.
So, as far as Berelowitz was concerned, he had opted out of the research either because Wakefield was intent on pursuing the MMR theory or because the media seemed determined to pursue it. Both these reasons gave Berelowitz a way out, a way of setting himself free from his association with Wakefield and his 'crimes'.
Dr Berelowitz would, he said, have nothing to do with Wakefield after the press conference. So vehement was he on this matter, that it occurred to me for a second that he was going to say that Wakefield had forged his signature on the protocol form for subsequent research in which he had clearly been involved. In the event, however, Berelowitz claimed that he was tentatively involved in the research in name only and after a time had not gone through with any involvement. His parting shot on this matter was the simple logic that Paul Shattock was involved in the research and he, Dr Berelovitz would never be involved in anything in which Shattock was involved because his research methodology had been found wanting.
In many ways Dr Berolovitz was hoist by the same petard as all the other prosecution witnesses. He had willingly taken part in the research for a period of time, and he, as those before him, now had to somehow cast that involvement in an innocent light, while appearing happy to endorse the prosecution against Wakefield.
This situation is perhaps the worst in which any prosecutor could find themselves, calling upon a gaggle of reluctant witnesses who should, if the defendants are in fact guilty, all be with them in the dock. This predicament further accounts for the manner in which Miss Smith and Owain Thomas, the prosecutors, often appear to all intents and purposes to be presenting the case for the defence when leading their witnesses through their evidence-in-chief.
Take the matter of Dr Berelowitz and lumbar punctures. The GMC prosecution have presented these as highly invasive, risky procedures which should on no account be used on children; they were portrayed as arcane and evil experimental methods. But how could Dr Berelowitz agree with the prosecution on this matter? If he did, he too would surely be admitting guilty involvement. So, on this, as on a number of other matters, Berelowitz, witness for the prosecution, essentially gave evidence for the defence.
He had, he told the hearing, done his own research into lumbar punctures and children, just to assure himself that he was not involved in anything unethical. His quick perusal of the literature had led him to believe that lumbar punctures were commonly used in a whole series of clinical situations involving children and were used in research by some of the most authoritative institutions in Britain and America.
Dr Berelowitz had to make a similar defence on the issue of ethical approval, another of the main planks of the prosecution case. On this he maintained very clearly, as others have done before him, and as others will no doubt do after him, that the writing up of a case-series does not require ethical approval.
It has been apparent from the first day of the hearings that the prosecution is leaking like a stricken boat trying to get to harbour in a storm. Not only has Miss Smith presented portions of the defence case, but the GMC is having to depend upon, in the main, entirely reluctant witnesses who are busy watching their own backs.
The last week has been a week of extremes. It began with the pleasant and clear minded evidence of Mrs Cowie, a solicitor who worked for what was at the time the Legal Aid Board (LAB). Richard Barr, the solicitor who by 1994 had been approached by a number of parents of potentially vaccine damaged children, had applied to the LAB for money to fund research which might, or equally might not, turn out to be of use to these claimants.
That this money had apparently been used by Dr Wakefield for his research and then not declared in his Lancet paper was a main plank of the prosecution evidence. Cowie was a generous witness who seemed completely in control of her independent position. Under cross examination she was happy to tell the panel that the money which had originally been sent to Dawbarns Solicitors, had later been paid to the Royal Free Hospital’s School of Medicine.
Instead of insisting, as the prosecution might have wanted her to, that the money was ring-fenced for an exact and explicit purpose, she informed Mr Koonan, counsel for Dr Wakefield, that the money was intended for generic work in the area. The money and the research were, she said, 'like a melting pot', it was to cover 'what was going on', and could happily be moved from one head, or research project, to another.
The Last Two GPs
During the week, two more GPs of the anonymous children written up in the Lancet paper, were called. Although admittedly, calling the GP’s was better for the prosecution than calling the parents, on the whole the prosecution gained next to nothing from bringing them to court.
Both GPs gave evidence and were cross examined on the matter of their having let the patients out of their grasp and, as it were, allowing them to be self-referred by their mothers to the Royal Free. Both GPs were of a similar mind; that the cases were complex and their symptoms presented a condition with which they were by no means familiar. This inadvertent lack of knowledge had led to a series of referrals in both cases, which might be considered in hindsight to have been ‘casting around’ for a solution.
Both GPs refused to fall in line behind the prosecution supposition that in referring the children to the Royal Free the doctors had given up their patients to the devil. Both declared with ringing common sense that they had done what was best for their patients and their parents. What is more, both felt that their actions had been thoroughly vindicated when they received the discharge summary from the Royal Free and when later it became apparent that the two patients had been offered a believable diagnosis and treatment which had in differing degrees helped their condition.
The second of the GPs was an ebullient man who despite being called for the prosecution, determinedly spoke for the defence. His evidence was packed with common sense and a humble acceptance that there were people in the profession who might know more than he did.
At one point during his cross examination this doctor put succinctly into words the thoughts that had been on the minds of most of the other doctors. Explaining that he had reached a stage where he was not concerned about the child attending the Royal Free or being subjected to investigations he said; 'I was pleased that the child was being dealt with and was glad that the mother was behind the referrals. Anything was worth a try'.
By the time that this GP appeared at the end of the week, it was apparent that the prosecution had slightly changed direction. Whereas the previous group of GPs had all been tarred with the brush of sending child patients on an illegitimate caravan to be experimented upon by Dr Wakefield, the two later doctors were charged with having helped Wakefield with his obviously nonsensical research. Research which claimed that MMR caused autism.
In fact it didn’t matter, because all the GPs appeared worthy, conscientious and sensible in the face of the rather haphazard prosecution. Apart from one unfortunate remark by a doctor who suggested a patient’s mother was searching too hard for a cause and a viable treatment, when she should perhaps learn to live with her son’s condition, most of the GPs gave credence to the parent’s feelings.
The fact that these worthy doctors had been brought to London in order to give evidence against three other doctors and, in a sense, against their patients and their parents made one wonder at the GMC's political turpitude.
In an odd way, the presentation of evidence by all the GPs gave one new faith in the average doctor. All seemed unaffected by the ideological blandishments of the Department of Health and unwilling to carelessly throw in their lot with their own regulatory body. They were independent and happy to admit that they had acted in the interests of the patient and the patient’s family. All of them expressed their empathy for the terrible circumstances which had befallen the parents and in comparison with the apparently unfeeling approaches of Miss Smith and Owain Thomas, they came across as intellectually engaging and sympathetic to both the parents and the children.
The end of facts
It might almost be true to suggest that the facts of the case against Wakefield, Walker-Smith and Murch have, with the general practitioners and the expert on ethics, almost been exhausted and what we might expect from this point onwards are ideologically versed witnesses.
On Thursday August 2nd, a Dr Kirrage gave evidence and one was forced to wonder yet again about the sense of the prosecutors bringing forward lower tier apparatchik’s to make their case. Kirrage came to the GMC hearing from that very heart of darkness, perfidy and spin which is the contemporary Health Protection Agency. In 1997 he had been a consultant working for Worcestershire Health Authority, it was his job to assess Extra Contractual Referrals (ECR) from Worcestershire Health Authority to others which provide specialised services.
A mother had approached her Consultant Paediatrician, with her son’s case. The consultant appears to have taken a jaundiced view of both the mother and the child. Despite having no real idea himself of how a diagnosis might be reached, he had bridled at the suggestion that the child be referred to the Royal Free, saying that he could not see how the child might benefit.
To get support for this decision, based upon ignorance, he communicated the details of the case to Dr Kirrage. Kirrage in turn had immediately sought advice from a friend in high places, Dr Elizabeth Miller. Miller had told him that Andrew Wakefield’s theories and research were now discredited and that there was no link between MMR and autism. In her opinion it was best not to refer the child to the Royal Free.
Using a pro-vaccine propaganda leaflet sent him by Miller, that he copied into an apparently personal letter, Kirrage wrote back to his consultant friend. He suggested that the consultant send a copy of this letter to the parents, at the same time informing the child’s mother he could not see that either the child or the family would gain anything from travelling to the Royal Free in London.
What made this apparently ideologically motivated decision even more hurtful was the fact that neither the consultant nor Kirrage appeared to have the faintest notion of how they might get a proper diagnosis or specialised treatment for the child in their own Health Authority area. They were, as the mother wrote in a heart wringing letter to the consultant, dooming her son to incarceration in an institution where he would be drugged to keep him manageable.
By the end of the hearing’s third week, most of those parents, and others associated with the Wakefield camp, had a more or less clear picture of the pressure which had been brought to bear on Dr Wakefield as he began treatment of the cases which were to be reported in the Lancet paper published in February 1998.
If anyone wanted confirmation of the very personal feud which had begun against Dr Wakefield inside the Royal Free medical school, they need have looked no further than the evidence of Professor Zuckerman, who had at that time been the Dean of the school. The strategy in bringing forth Professor Zuckerman was resoundingly clear from the start of his evidence.
Professor Zuckerman was a wholehearted supporter of vaccination and immunisations. He was an advisor to the World Health Organisation, he had been an adviser over many years to the Department of Health and was a contributor to over 1,000 journal papers and articles. He had experience in epidemiology and in the safety and development of vaccines.
Professor Zuckerman did not stop, throughout his evidence, making the point that while the whole world agreed with his views about the safety of MMR, only one person in the world, Dr Wakefield, offered the contrary view. Opinion is divided, one might say.
Professor Zuckerman’s evidence was threaded through with campaigning strategies aimed solely at Dr Wakefield. The first matter at issue was that Dr Wakefield had received money from the Legal Aid Board to carry out research. As far as Zuckerman was concerned this was funding from the devil given to further the argument that Hell was a pleasant place. It was funding which led straight into a conflict of interest, possible legal confrontation with the government and a public health debacle waiting to happen.
Professor Zuckerman made the point on a number of occasions that in 45 years, he had never come across funding for research which entailed 'lawyers directing the research'. He didn’t have to explain this in any depth and defence council never put to him the endless evidence that in much research into workplace illness, in for example, the chemical industry, not only is the funding supplied by associate industrial interests but the work is carried out in industry funded establishments with data provided entirely by the industry in question.
Professor Zuckerman was only getting warmed up with these arguments. Later as he got deeper into defence counsel’s cross examination his evidence seemed to have less and less to do with real academic issues and more to do with an implacable abhorrence that gripped him in relation to Dr Wakefield.
Professor Zuckerman returned again and again to what appeared to be his most central concern, that unproven research results of this kind could only damage public health and on these grounds entirely they must not be allowed publication. Anyone paying attention to Zuckerman’s arguments couldn’t fail to conclude that he would rail against any and all research which postulated adverse reactions to vaccination on the same grounds.
At the end of the first day when Zuckerman was still being led through his evidence-in-chief, a serious matter occurred which threw into contrast the different approaches of the defence and the prosecution.
Miss Smith was almost finished taking Professor Zuckerman through his evidence, when Dr Wakefield’s counsel rose. He told the panel that Miss Smith had allowed Professor Zuckerman to give evidence which was not in the statement which had been served on the defence. Sometimes, a witness might do this on a matter which is non-contentious and which the defence does not need warning of in order to conduct their cross examination. This particular matter, however, was particularly value laden – whether or not Dr Wakefield had refused to send his research to another independent laboratory to seek replication.
Clearly, if Dr Wakefield’s counsel was to cross examine on these new allegations, he would have to go through the matter in detail with his client. In the circumstances he asked simply that the days hearing be brought to an end (it was, anyway, almost over) and be resumed again tomorrow after he had taken the opportunity of talking the new evidence through with Dr Wakefield.
It is as if such professional and real demands push buttons for Miss Smith, for she responded as she had done previously; acerbically. She pantomimed the suggestion that Mr Koonan was always doing this, suggested that it wasn’t an important piece of evidence and accused him of time-wasting. If we were to keep going over the planned time, she said, we would never get the case finished. Mr Koonan argued that we were talking about a matter of justice and not a matter of administration.
Both the legal advisor to the Panel and the Panel Chairman came to Mr Koonan’s aid and told the hearing that Professor Zuckerman’s evidence would be continued in the morning. On his dismissal for the day, Zuckerman could not help but make a special plea on his own behalf, to the Panel. They had to realise he said, just how difficult and painful this situation was for him.
Professor Zuckerman finished his evidence the following day, during which time it became clear beyond any doubt at all that he was The First True Prosecution Witness. As Mr Koonan was later to suggest, he argued a case throughout his evidence, and the foundations of that case stood out like burning charcoal thrown into the snow.
Zuckerman clearly detested Wakefield. He poured sugary flattery on both Professor Murch and Professor Walker-Smith. Answering cross examination from Dr Wakefield’s counsel, he was completely defensive. Obviously feeling trapped and threatened, he was always on the brink of leaving his chair and the hearing.
However, much of what Zuckerman said made little sense. While he claimed to have been at odds with Wakefield from the start, he thought the Lancet paper was a very good piece of work. While he sought evidence from sources outside the University about Wakefield’s work he failed to discuss his doubts with Dr Wakefield himself. He continually quoted all the august bodies of which he was a part, yet failed to answer the simple question of what you might do if research did point out a serious public health problem with adverse reactions to vaccination. Zuckerman seemed to take it for granted that any reports of adverse reactions to vaccines could not be based on good science.
But the most intriguing question of all related to the press briefing shortly before the publication of the Lancet paper. Zuckerman had helped organise the ‘conference’ and he seemed happy to chair it. He had a preview of its structure and the questions it would address. However, when a journalist at the end of the briefing, asked what approach parents should now have to the MMR combination vaccine, Zuckerman directed the question to Dr Wakefield. This was despite the fact that he knew Wakefield to have had concerns about the polyvalent vaccine for many years. Despite the fact Zuckerman was at that time in receipt of a letter from Dr Wakefield in which it was explicitly stated that, if asked at the press briefing, Wakefield would make clear those concerns.
As soon as Dr Wakefield had made the statement which apparently ended his career at the Royal Free, suggesting that it might be better to suspend use of MMR until research had proved its safety or otherwise, Zuckerman re-directed the question to Professor Murch. Murch quickly expressed his complete support for the vaccine. Why, one might ask, had Zuckerman directed the question to Wakefield?
Although Zuckerman had begun the morning at 9.35 in a seemingly reconciliatory mood, by 10.00am he was showing all the truculence of the previous day. Instead of answering simply ‘no’ to questions with which he disagreed, his returns to Mr Koonan were always qualified; ‘certainly not’ and ‘absolutely not’ he kept repeating. This showed defensiveness beyond any provocation offered by the defence.
As time slipped by, Professor Zuckerman quickly found himself distractedly hissing and booing his answers. It soon got to the point where Mr Koonan had to put it to Zuckerman that far from giving objective evidence, he was ‘arguing a case’; not that the case he was arguing was rational.
Eventually, the two protagonists, as they had gradually become, drifted rudderless into a head on confrontation. Zuckerman began to rise to every question as if it were a personal insult. Mr Koonan closed in, forcing Zuckerman into a corner. By 10.15, Koonan had arrived again at the extra evidence about replication of research results which had been offered by Zuckerman on the previous Friday.
Slowly with steady articulation, Mr Koonan put it to Professor Zuckerman that he had alleged Dr Wakefield was implacably opposed to any attempts at replication of his work, although, in fact, replication did take place. 'It’s as simple as that', Mr Koonan blandly ended the statement. There were signs, then, that Zuckerman was about to lose it.
Koonan’s next set of questions dealt with the press briefing. He suggested to Professor Zuckerman that Zuckerman was not displeased to have the paper published by Dr Wakefield and other researchers from the Royal Free. That he thought the work reflected well on the medical school. He was even, Mr Koonan suggested, pleased to chair the briefing.
At this, Professor Zuckerman lost his footing and began to slide down the cliff face, his terse venomous responses coming almost automatically. 'I absolutely reject this. I absolutely reject this. I absolutely reject this' he said in triplicate at one point.
And then, as if caught up in a shouting match with a mortal enemy he began to interrupt Mr Koonan’s well phrased questions.
The Chairman asked Professor Zuckerman to let Mr Koonan finish his questions.
Zuckerman all but left his seat, saying that he would have to get his own legal adviser to sit with him, if this kind of questioning did not stop.
Miss Smith intervened to draw upon some secret set of rules, about cross examination. 'Mr Koonan is not entitled to phrase his questions as statements'. This was news to the Panel Chairman who said that he had heard both the prosecution and the defence ask questions in this way; using the words 'I put it to you that ...'
The panel broke-up at that time, perhaps in the hope that Professor Zuckerman would regain control of himself. Oddly, in all the following exchanges, the last questions from Mr Koonan and some very polite exchanges with counsel for Professor Walker-Smith and Professor Murch Zuckerman kept himself under perfect, even polite control.
At the end of Zuckerman’s evidence one was left with the impression that he had performed cleverly, expressing his personal detestation of Dr Wakefield, defending his professional interests and managing to avoid answering the most damaging exchanges with Mr Koonan by utilising a display of histrionics.
I have been interested to hear the Chairman of the panel refer to the proceedings on a number of occasions as an ‘enquiry’. By no stretch of the legal imagination could this be the case. The proceedings are adversarial and at their heart is a hard brought and fought prosecution.
The prosecuting authority is the General Medical Council, which is acting in concert with government public health policy and pharmaceutical company marketing strategies. The ultimate point of the prosecution is, from the prosecutor’s perspective, to defend the regulatory tenets of industrial scientific and medical research, isolate Dr Andrew Wakefield, and cast him out beyond the pale of informed medical opinion.
Were this an ‘enquiry’, an independent GMC would, from the beginning, have produced evidence of process, which would cast light on the motives of the sole complainant in the case, Brian Deer. Had it been an enquiry, many hours would have been spent recording the evidence of all the parents who had cajoled, fought and pushed their way to the Royal Free in order to get their children the best medical attention available in Britain.
This hearing is to all intents and purposes, a ‘trial’. As such, it is remarkable in contemporary society for not questioning, in any degree whatsoever, issues arising from the power of the pharmaceutical companies, their vested interests and their marketing strategies. The word ‘kangaroo’ became associated with the word ‘court’ presumably on account of that animal’s capacity to jump over great swathes of ground.
Posted - 08/17/2007 : 19:40:09
| Tuesday 14th August GMC hearing
Here is an account of what happened today at the hearing...
By Olivia Hamlyn (daughter of Susan, sister of Francis)
I arrived at about 11.15am and so missed the prosecution cross-examining Dr Revell. He was the Head of Histopathology at the RFH at the time the Lancet paper came out etc.
Miller [defence counsel] was the main cross-examiner and most of his cross-examination as far as I could see was spent 1. establishing the relationship between Revell and his department and those carrying out the clinical work and research work and 2. The difference between clinical work and retrospective research work.
Revell made it clear that where investigations were taking place, i.e., here involving slides taken from colonoscopies, there was much discussion between clinicians and pathologists in weekly meetings. He didn't attend the meetings and therefore couldn't say what went on in them exactly, but their purpose was to reach a consensus about what had been found and about the care and treatment of patients and so that departments would be in communication with each other. These meetings were mainly in Dr Sue Davis' (later witness) hands. He made it clear though, in summary, that all processes used for the care etc. of patients were professional and contained nothing to raise concern.
Miller then established that should the interpretation of the slides change after later examination for research purposes, then treatment of the patient would not change. Furthermore, that in order to conduct retrospective research now, the patient's consent would be needed. This was a result of the Human Tissue Act (2004), which hadn't been around when this research was being carried out. Revell did regard it as a retrospective study, he said and added that Dr Davis and Dr Dillon did their own retrospective review of the same slides in order to verify the description in the article. He assumed this review was the same as that referred to in the Lancet paper.
In relation to the Lancet paper, he said that what had been found were interesting observations and would need a larger study.
In response to panel questions, he thought there had been nothing unusual about the biopsies except that one was for an autistic child. He had concerns about this so investigated as part of his job to check that the NHS was being used appropriately. He was obviously satisfied. It was unusual for a child with autism to be biopsied but then again, he wasn't a gastroenterologist. When pressed about the necessity for ethical approval he said in 1998 one wouldn't have necessarily needed ethical approval for writing retrospective case studies but couldn't remember when it changed.
Next up was Professor David Candy who is a paediatric gastroenterologist and was a peer-reviewer to the Lancet paper. Smith [prosecuting counsel] took him through the process by which one becomes peer-reviewer and the background to his being asked to peer-review the Lancet paper. Briefly, one can be nominated by the authors of the paper or chosen by the editor (there are probably other ways too). This was his first peer-review for the Lancet although he had experience doing it for other journals. He received two papers: the first one being the clinical paper (the one which was published) and the second one being a basic science paper (which was actually rejected) and a letter from John Bignall of the Lancet asking him for a swift review of both warning him of the implications of publishing these papers and requiring him to make sure the findings were absolutely watertight.
Several clear points came out in his cross-examination which can't have done the prosecution much good.
Firstly that he knew the papers would be excellent because he knew and admired Professor John Walker Smith. He needed to make no major amendments and would have been surprised if he had had to, he said. He said that the second paper especially led to his endorsement of the pair.
Secondly, the major criticism of the Lancet paper both in the editorial that accompanied it and from other sources was that there was a lack of virological evidence/virus infection to support/explain the claims made in it. He said, however, that the these criticisms would have been met if only the second scientific paper has been published too, along with the first paper. The first paper implicated the measles component of MMR because the authors knew what the second paper said, i.e. The presence of the measles protein in the gut had been identified. He also noted that it was puzzling that the editorial should contain such harsh criticism of a paper which had been accepted for publication!
Thirdly, he talked about the research techniques used to detect the measles virus such as PCR and these were techniques which he had faith in and had experience of. He gave both papers positive reviews and doesn't know why the second paper was rejected. He conceded however, that because the peer-review process was not transparent then and he didn't know who the other reviewers were, then it could have been negatively reviewed by someone with more expertise. But then again, we won't find out for sure why the second paper was rejected because the no one seems to know what happened... However, he made it clear that he was not happy that only the first paper was published without, as he put it, "the missing piece of the puzzle" and felt that it would have been better to publish nothing, rather than just the clinical paper. He described the two papers as "indivisible" and said that the observations in the first paper were strengthened and confirmed by the second paper. Koonan [defence counsel] suggested that the publication of the first paper without the second looked like an error and Candy replied that it had definitely been an error not to consult the peer-reviewers on this matter. He felt that if there had been a disagreement among the peer-reviewers then the authors should have been asked to comment and it should have been resolved that way. Apparently this is Horton's usual method, as he stated last week, but evidently it didn't happen...
Fourthly, he felt that taken together, the findings of the two papers were watertight and both were well-written and excellent research. He also said that the existence of measles viral infection in the bowel was a revolutionary finding. He said he was aware of what measles virus could do to the brain and that it was not implausible that the measles virus could damage the bowel and brain.
He made it clear too that he was annoyed at the criticism insinuating that the peer-review process had failed and because he was unable to answer due to the need to remain confidential. He said the concern expressed by third parties could have been avoided with the publication of the second paper and the level of adverse comment could have been lower.
Finally, in response to panel questions, he reiterated his confidence in the findings of the paper because of the quality of the authors and the reputation of the institution.
Apparently tomorrow there's just going to be wrangling between the two sides over whether the witness statement of Dr Clifford Spratt is admissible as he is too ill to attend. There is no hearing on Thursday and Friday [16th and 17th August].
Apparently too, David Salisbury will be called to witness at the start of next week.